ABSTRACT
The number of chronic kidney disease (CKD) patients is growing rapidly. In 1998 in the United States alone, 320 000 patients required dialysis, 13.3 million had mild to severe nondialysis-dependent CKD and another 5.9 million had CKD without decreased glomerular filtration rate (GFR).1 Coronary artery disease (CAD) has a high prevalence and is the major cause of mortality in CKD patients (Figure 4.1).2-5 CKD patients also have an increased prevalence of peripheral arterial and cerebrovascular disease, left ventricular hypertrophy, and cardiomyopathy. Whether the increased CAD prevalence in CKD is related to the higher prevalence of traditional risk factors or the presence of risk factors unique to CKD is not totally clear (Table 4.1).6 A discussion of the relationship of these risk factors to increased coronary events is beyond the scope of this chapter and the reader is directed to recent reviews.6,7 However, it should be noted that a recent study of 1249 CKD patients has suggested that traditional risk factors are more important as predictors of cardiovascular mortality than the risk factors unique to CKD patients.8 It is clear, however, that CKD increases the risk of a cardiovascular event and is associated with a worse outcome if it occurs.This chapter will review the increased cardiovascular risk and worsened prognosis associated with renal dysfunction.
